House passes certificate of need reform on close vote

RICHMOND – Some of furthest reaching hospital reforms of this session limped from one chamber to the other Monday, with supporters promising amendments before anything is final.

House Bill 193 would overhaul the state's Certificate of Public Need rules, which empower state officials to deny hospital expansions and block the opening of stand-alone imaging and surgery clinics unless there's a demonstrated need.

Advocates say the current system stymies competition and drives up prices. Hospital executives say the House proposal goes much too far, and that more limited reforms are the way to go.

The bill cleared the House of Delegates Monday 52-46, at least in part on the strength of repeated promises that the bill will be altered as it moves through the state Senate.

Republicans made up most of the support, but the vote was bipartisan and the issue has divided people in both parties.

Lobbying has been intense. The Virginia Hospital and Healthcare Association ran a commercial earlier this month telling voters this bill would close local hospitals.

House Majority Leader Kirk Cox called that ad "one of the worst I've ever seen." He called House Bill 193 "really meaningful" Monday, telling delegates this is "one of those moments" that could change things for the better in Virginia for many years to come.

With no Senate bill still alive on this issue, it was up to the House to advance imperfect legislation, said Cox, R-Colonial Heights. Tuesday at midnight is the deadline for legislation to move from one chamber to the other.

"If we don't move forward, no one else will," Cox said.

The bill steps down state regulations over the next two years, opening the health care field to more competition. The hospital association says the bill amounts to repeal, not reform, and that it would leave facilities vulnerable to closure as more profitable services are offered by competitors who don't have to fund emergency rooms.

Del. John O'Bannon, R-Richmond, said Monday that protections for rural hospitals and requirements for charity care at new facilities can be strengthened before this bill is finalized.

The hospital association said the bill passed Monday "calls for COPN repeal without addressing the fundamental financial challenges related to adequately funding health care access and the strain that places on local hospitals and health systems."

Hospitals have long complained of Medicaid reimbursements far below what they consider the actual cost of care. They face new federal cuts now, even as Virginia has declined to expand Medicaid as contemplated under the Affordable Care Act, which would inject billions into the health care industry.

"Every party that I've talked to understands the COPN system needs reform," Mason said. "O'Bannon's bill seems to do much to much too fast."

Dels. Brenda Pogge, R-Norge, David Yancey, R-Newport News, and S. Chris Jones, R-Suffolk, voted yes. Yancey and Pogge said they expect the bill to improve as it continues through the legislature so that, in Yancey's words, "all parties can work together to find a way to keep medical costs low."

Said Pogge: "I think it's a bill about access and affordability."

A less controversial measure on certificate of need, House Bill 350, also cleared the House Monday, 94-4.